Remote Senior Prepayment Program Integrity Lead

Geisinger; Pennsylvania; Hybrid; USD 90,000 - 130,000; Full time

Job summary

Geisinger is seeking a Prepayment Program Integrity Manager to lead our prepayment audit and vendor oversight efforts. This role directs clinical, coding, and audit professionals to optimize payment accuracy while balancing provider experience and operational efficiency.

You will drive strategies, monitor performance, and ensure compliance with federal/state regulations, with a focus on cost savings and high-quality audit outcomes.

Qualifications

• Bachelor's Degree in Nursing or related field required; equivalent experience may be considered.
• Minimum 5+ years in Payment Integrity, Claims Auditing, Healthcare Compliance, SIU or revenue integrity.
• Minimum 3+ years in leadership roles supervising clinical, coding, or audit teams.
• Experience managing prepayment review programs and external audit vendors.
• Strong knowledge of healthcare reimbursement methodologies and regulatory requirements.

Responsibilities

• Lead day-to-day operations of the Prepayment Program Integrity function.
• Develop and implement auditing strategies to improve payment accuracy and savings.
• Oversee vendor performance, contracts, and improvement of audit results.
• Manage prepayment claim auditing across professional, facility, and ancillary claims.
• Oversee provider appeals and ensure timely, compliant resolution.

Skills

Analytical thinking

Communication

Leadership

Fraud detection and prevention

Fraud management

Education

Bachelor's Degree in Nursing

High School Diploma or GED

Tools

Healthcare coding

Job description

Geisinger is seeking a Prepayment Program Integrity Manager to lead our prepayment audit and vendor oversight efforts. This role directs clinical, coding, and audit professionals to optimize payment accuracy while balancing provider experience and operational efficiency.

You will drive strategies, monitor performance, and ensure compliance with federal/state regulations, with a focus on cost savings and high-quality audit outcomes.